2013 World Drug Report Insights

WORLD
2013
DRUG
REPORT
WORLDDRUGREPORT2013
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ISBN 978-92-1-148273-7
The World Drug Report presents a comprehensive overview of the latest developments in
drug markets. It covers production, trafficking, consumption and the related health
consequences. Chapter 1 of this year’s Report examines the global situation and the latest
trends in the different drug markets and the extent of illicit drug use, as well as the related
health impact. Chapter 2 addresses the issue of new psychoactive substances (substances
of abuse that are not controlled by the Drug Conventions, but which may pose a public
health threat), a phenomenon that can have deadly consequences for their users, but which
is hard to control with its dynamic producers and fast-mutating “product lines” which have
emerged over the last decade.
The Statistical Annex is published electronically on a CD-ROM, as well as the UNODC web-
site: http://www.unodc.org/unodc/en/data-and-analysis/WDR-2013.html

UNITED NATIONS
New York, 2013
World Drug Report
2013
UNITED NATIONS OFFICE ON DRUGS AND CRIME
Vienna

© United Nations, May 2013. All rights reserved worldwide.
ISBN: 978-92-1-148273-7
e-ISBN: 978-92-1-056168-6
United Nations publication, Sales No. E.13.XI.6
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policies of UNODC or contributory organizations, nor does it imply any
endorsement.
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do not imply the expression of any opinion whatsoever on the part
of UNODC concerning the legal status of any country, territory or city or its
authorities, or concerning the delimitation of its frontiers or boundaries.
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Website: www.unodc.org

iii
WORLDDRUGREPORT2013
PREFACE
The findings of the World Drug Report 2013 deliver
important lessons for the forthcoming high-level review
of the commitments that countries reaffirmed in 2009 on
the measures for drug control. These measures are laid out
in the Political Declaration and Plan of Action on
International Cooperation towards an Integrated and
Balanced Strategy to Counter the World Drug Problem.
At the global level, there has been an increase in the
production and misuse of new psychoactive substances,
that is, substances that are not under international control.
The manufacture and use of substances that are under
international control remain largely stable as compared
with 2009, although trends in drug supply and demand
have been unequal across regions and countries and across
drug types. Member States that are party to the three
international drug control Conventions, which were
adopted to protect the health and welfare of mankind,
remain committed to the drug control system. Evidence
shows that while the system may not have eliminated the
drug problem, it continues to ensure that it does not
escalate to unmanageable proportions.
We have to admit that, globally, the demand for drugs has
not been substantially reduced and that some challenges
exist in the implementation of the drug control system, in
the violence generated by trafficking in illicit drugs, in the
fast evolving nature of new psychoactive substances, and
in those national legislative measures which may result in
a violation of human rights. The real issue is not to amend
the Conventions, but to implement them according to
their underlying spirit.
While intensified competition in trafficking in cocaine has
led to growing levels of violence in Central America, the
problem will not be resolved if drugs are legalized.
Organized crime is highly adaptive. It will simply move to
other businesses that are equally profitable and violent.
Countering the drug problem in full compliance with
human rights standards requires an emphasis on the
underlying spirit of the existing drug Conventions, which
is about health. Advocacy for a stronger health perspective
and an interconnected re-balancing of drug control efforts
must take place. As experience has shown, neither supply
reduction nor demand reduction on their own are able to
solve the problem. For this reason, a more balanced
approach in dealing with the drug problem is a necessity.
This includes more serious efforts on prevention and
treatment, not only in terms of political statements, but
also in terms of funds dedicated for these purposes.
This year’s World Drug Report shows the extent of the
problem associated with new psychoactive substances and
the deadly impact they can have on their users. The issue
of new psychoactive substances is one that the international
community will review at the high-level session of the
Commission on Narcotic Drugs in 2014. As is the case
with traditional drugs, international action against these
substances must focus on addressing both supply and
demand. The paucity of knowledge on the adverse impacts
and risks to public health and safety, coupled with the fact
that new psychoactive substances are not under
international control, underscores the importance of
innovative prevention measures and sharing of good
practices between countries.
The multitude of new psychoactive substances and the
speed with which they have emerged in all regions of the
world is one of the most notable trends in drug markets
over the past five years. While the existing international
control system is equipped to deal with the emergence of
new substances that pose a threat to public health, it is
currently required to provide a response commensurate
with the unprecedented fast evolving nature of the
phenomenon of new psychoactive substances. Some
countries have adopted innovative approaches to curb the
rise of these substances, but the global nature of the
problem requires a response based on international
cooperation and universal coverage. Such a response should
make use of all the relevant provisions of the existing
international drug Conventions. In addition, in
strengthening the international control system, a systematic
evaluation of the appropriateness of some of the innovative
approaches at the national level should be encouraged.
The detection and identification of emerging substances
is a fundamental step in assessing the potential health risks
of new psychoactive substances and, as such, scientific,
epidemiological, forensic and toxicological information on
these substances needs to be collected, updated and
disseminated. As requested by the Commission on Narcotic
Drugs in its resolution 56/4 on enhancing international
cooperation in the identification and reporting of new
psychoactive substances, the United Nations Office on
Drugs and Crime (UNODC) is ready to assist the
international community by building a global early
warning mechanism that will provide Governments with
the necessary information on new psychoactive substances,
particularly scientific data that are essential in the
development and implementation of evidence-based
responses.
As we approach 2014 and the withdrawal of international
forces from Afghanistan, that country requires concerted
efforts on the part of the international community. The
United Nations, and particularly UNODC, will need to
provide far greater assistance to bring counter-narcotic
programmes into the mainstream of social and economic
development strategies so as to successfully curb the current
cultivation and production of opium and the worrying

PREFACEiv
high use of opiates among the Afghan population.
UNODC is working to achieve this through its country
programme, one of its largest in the world, as well as its
integrated regional programme for Afghanistan and
neighbouring countries.
The trends in new emerging routes for trafficking of drugs
and in the production of illicit substances indicate that the
continent of Africa is increasingly becoming vulnerable to
the drug trade and organized crime, although data from
the African region is scarce. While this may further fuel
political and economic instability in many countries in the
region, it can also lead to an increase in the local availability
and consumption of illicit substances. This, therefore,
requires the international community to invest in evidence-
informed interventions for the prevention of drug use, the
treatment of drug dependence, the successful interdiction
of illicit substances and the suppression of organized crime.
The international community also needs to make the
necessary resources available to monitor the drug situation
in Africa.
Regarding people who inject drugs and who live with HIV,
the World Drug Report 2013 shows that there have been
some improvements. Those countries which implemented
a comprehensive set of HIV interventions were able to
achieve a reduction in high-risk behaviours and in the
transmission of HIV and other blood-borne infections.
This holds the promise that countries can achieve the
targets set out in the 2009 Political Declaration and Plan
of Action by implementing and expanding prevention and
treatment services for people who inject drugs. However,
there is still an immense task ahead to achieve the
commitment made by the General Assembly in the 2011
Political Declaration on HIV and AIDS: Intensifying Our
Efforts to Eliminate HIV and AIDS, which sets out the
target of reducing new HIV infections by 50 per cent
among people who inject drugs. This warrants significant
scaling up of evidence-based HIV interventions in countries
where the epidemic is driven by injecting drug use.
Illicit drugs continue to jeopardize the health and welfare
of people throughout the world. They represent a clear
threat to the stability and security of entire regions and to
economic and social development. In so many ways, illicit
drugs, crime and development are bound to each other.
Drug dependence is often exacerbated by low social and
economic development, and drug trafficking, along with
many other forms of transnational organized crime,
undermines human development. We must break this
destructive cycle in order to protect the right of people to
a healthy way of life and to promote sustainable economic
growth and greater security and stability. It is, therefore,
important that drugs are addressed when developing the
post-2015 development agenda.
Yury Fedotov
Executive Director
United Nations Office on Drugs and Crime

v
WORLDDRUGREPORT2013
CONTENTS
PREFACE iii
EXPLANATORY NOTES vii
EXECUTIVE SUMMARY ix
1. RECENT STATISTICS AND TREND ANALYSIS OF ILLICIT DRUG MARKETS
A. Extent of illicit drug use and health consequences 1
B. Overview of trends related to drug supply indicators, by drug type and region 17
C. Cannabis market 24
D. Illicit opiate market 30
E. Cocaine market 37
F. The market for amphetamine-type stimulants 49
G. Conclusion 57
2. NEW PSYCHOACTIVE SUBSTANCES
A. Introduction 59
B. New psychoactive substances: concepts and definitions 60
C. The recent emergence and spread of new psychoactive substances 67
D. Conclusions and future course of action 113
ANNEX I i
Maps and tables on drug demand
ANNEX II vii
Maps and tables on drug supply
ANNEX III
Regional groupings xv
GLOSSARY xvii

Editorial and production team
The World Drug Report 2013 was produced under the supervision of
Sandeep Chawla, UNODC Deputy Executive Director and Director,
Division for Policy Analysis and Public Affairs
Core team
Research and Trend Analysis Branch
Angela Me, Suzanne Kunnen, Kristina Kuttnig and Jaya Mohan.
Laboratory and Scientific Section
Justice Tettey, Beate Hammond, Sabrina Levissianos and Kristal Pineros.
Statistics and Surveys Section
Coen Bussink, Philip Davis, Yuliya Lyamzina, Kamran Niaz, Preethi Perera,
Umidjon Rahmonberdiev, Martin Raithelhuber, Ali Saadeddin, Janie Shelton
Antoine Vella and Irmgard Zeiler.
Studies and Threat Analysis Section
Anja Korenblik and Thomas Pietschmann.
The report also benefited from the work and expertise of many other
UNODC staff members in Vienna and around the world.

vii
WORLDDRUGREPORT2013
EXPLANATORY NOTES
The following abbreviations have been used in this Report:
AIDS acquired immunodeficiency syndrome
ATS amphetamine-type stimulant
BZP N-benzylpiperazine
CICAD Inter-American Drug Abuse Control
Commission (Organization of Ameri-
can States)
mCPP m-chlorophenylpiperazine
DEA Drug Enforcement Administration
(United States of America)
EMCDDA European Monitoring Centre for Drugs
and Drug Addiction
Europol European Police Office
GDP gross domestic product
ha hectare
HIV human immunodeficiency virus
INTERPOL International Criminal Police
Organization
LSD lysergic acid diethylamide
MDA methylenedioxyamphetamine
MDE methylenedioxyethylamphetamine
MDMA methylenedioxymethamphetamine
3,4-MDP-2-P 3,4-methylenedioxyphenyl-2-pro-
panone
MDPV methylenedioxypyrovalerone
4-MMC 4-methylmethcathinone
NPS new psychoactive substance
P-2-P 1-phenyl-2-propanone
PMK piperonyl methyl ketone
THC tetrahydrocannabinol
WHO World Health Organization
The boundaries and names shown and the designations
used on maps do not imply official endorsement or accept-
ance by the United Nations. A dotted line represents
approximately the line of control in Jammu and Kashmir
agreed upon by India and Pakistan. The final status of
Jammu and Kashmir has not yet been agreed upon by the
parties. Disputed boundaries (China/India) are represented
by cross hatch due to the difficulty of showing sufficient
detail.
The designations employed and the presentation of the
material in this publication do not imply the expression
of any opinion whatsoever on the part of the Secretariat
of the United Nations concerning the legal status of any
country, territory, city or area or of its authorities, or con-
cerning the delimitation of its frontiers or boundaries.
Countries and areas are referred to by the names that were
in official use at the time the relevant data were collected.
All references to Kosovo in the present publication should
be understood to be in compliance with Security Council
resolution 1244 (1999).
Since there is some scientific and legal ambiguity about
the distinctions between “drug use”, “drug misuse” and
“drug abuse”, the neutral terms “drug use” and “drug con-
sumption” are used in this report.
The data on population used in this report are from:
United Nations, Department of Economic and Social
Affairs, Population Division, World Population Prospects:
The 2010 Revision. Available from http://esa.un.org/wpp.
References to dollars ($) are to United States dollars, unless
otherwise stated.
References to “tons” are to metric tons, unless otherwise
stated.

ix
WORLDDRUGREPORT2013
The World Drug Report presents a comprehensive over-
view of the latest developments in drug markets. It covers
production, trafficking, consumption and related health
consequences. Chapter 1 of this year’s report examines the
global situation and the latest trends in the different drug
markets and the extent of illicit drug use, as well as the
related health impact.
Chapter 2 addresses the phenomenon of new psychoactive
substances (NPS), which can have deadly consequences
for their users but are hard to control, with dynamic, fast-
mutating producers and “product lines” which have
emerged over the past decade.
The global picture
Global drug use situation remains stable
On the whole, the global drug use situation has remained
stable. While there has been some increase in the estimated
total number of users of any illicit substance, estimates
show that the number of drug users with dependence or
drug use disorders has remained stable. The increase in the
annually estimated number of users is, to a large extent, a
reflection of an increase in the world population.
However, polydrug use, especially the combination of pre-
scription drugs and illicit substances, continues to be a
concern. The misuse of sedatives and tranquillizers is of
particular concern, with more than 60 per cent of the
countries covered in the report ranking such substances as
among the first three misused types of substances.
The increasing number of NPS appearing on the market
has also become a major public health concern, not only
because of increasing use but also because of the lack of
scientific research and understanding of their adverse
effects.
Injecting drug use and HIV remain a
public health concern
New data reveal that the prevalence of people who inject
drugs and those who inject drugs and are also living with
HIV in 2011 was lower than previously estimated: 14.0
million people between the ages of 15 and 64 are estimated
to be injecting drugs, while 1.6 million people who inject
drugs are living with HIV. This reflects a 12 per cent
decline in the number of people who inject drugs and a
46 per cent decline in the number of people who inject
drugs that are living with HIV since the 2008 estimates.
In 2011, the number of drug-related deaths was estimated
at 211,000. Most of those deaths were among the younger
population of users and were, to a large extent, preventable.
Opioids remained the most commonly reported group of
substances involved in drug-related deaths. There contin-
ues to be a major gap in the delivery of treatment services
for drug dependence: only an estimated one in six problem
drug users had received treatment in the preceding year.
Maritime trafficking poses challenge
to authorities
Given the large quantities of licit substances that make
their way across oceans and continents every day, in con-
tainers and even small boats, maritime trafficking poses a
particularly knotty challenge for the authorities.
East and West Africa seem to be gaining in prominence
with regard to routes for maritime trafficking. A new mari-
time route going southwards from Afghanistan via ports
in the Islamic Republic of Iran or Pakistan is increasingly
being used by traffickers to reach consumer markets
through East and West African ports. Since 2009, seizures
of heroin have risen sharply in Africa, especially in East
Africa, where they increased almost 10-fold.
Experience has shown that a maritime seizure is consist-
ently more likely to be larger than a seizure involving trans-
port by road or rail. In fact, although maritime seizures
constitute no more than 11 per cent of all cases across all
drug categories globally, each maritime seizure was on aver-
age almost 30 times larger than seized consignments traf-
ficked by air. Targeted interdiction efforts by the authorities
would enable them to seize larger quantities of drugs being
trafficked over water.
New drug trafficking routes
Traffickers are increasingly looking for new routes to sup-
plement the old ones: new land routes for heroin smuggling
seem to be emerging, e.g. in addition to the established
Balkan and northern routes, heroin is trafficked southward
from Afghanistan via the Islamic Republic of Iran or Paki-
stan, leading through the Middle East via Iraq. While the
Balkan trafficking route remains the most popular one, a
decrease in the amount of heroin being trafficked on this
route has been noted.
Moreover, Afghan opiates seem to be emerging as compe-
tition to opiates produced and consumed in the East and
South-East Asia subregion, as seizures made in countries
of that region show.
While it is clear that the African continent is becoming
increasingly important and vulnerable in terms of the pro-
liferation of trafficking routes, the availability of data is
very limited. In order to effectively monitor this worrying
trend, there is an urgent need to improve the data collec-
tion and analysis capacity of countries in the region.
Cocaine seizures in Colombia indicate that the Atlantic
route may be gaining in prominence as compared with the
Pacific route in maritime trafficking; linguistic ties appear
to play a role in cocaine trafficking from South America
EXECUTIVE SUMMARY

x WORLD DRUG REPORT 2013
to Europe via Brazil, Portugal and lusophone countries in
Africa. The cocaine market seems to be expanding towards
the emerging economies in Asia.
Overall trends across drug categories
Opiates
Trends with regard to the production and consumption of
opiates witnessed some major shifts.
The limited available data suggest that opioid use (prescrip-
tion opioids, heroin and opium) has gone up in parts of
Asia (East and South-East Asia, as well as Central and West
Asia) and Africa since 2009.
Use of opiates (heroin and opium), on the other hand,
remains stable (around 16.5 million people, or 0.4 per cent
of the population aged 15-64), although a high prevalence
for opiate use has been reported from South-West and
Central Asia, Eastern and South-Eastern Europe and North
America.
In Europe specifically, there are indications that heroin use
is declining, due to a number of factors, including an aging
user population in treatment and increased interdiction of
supply. Nevertheless, non-medical use of prescription opi-
oids continues to be reported from some parts of Europe.
Production-wise, Afghanistan retained its position as the
lead producer and cultivator of opium globally (74 per
cent of global illicit opium production in 2012). While
the global area under poppy cultivation rose by 15 per cent
in 2012, driven largely by increases in Afghanistan and
Myanmar, global opium production fell by almost 30 per
cent, to less than 5,000 tons in 2012, mainly as a result of
poor yields in Afghanistan. Mexico remained the largest
producer of opium in the Americas.
It appears that opium production in the Lao People’s Dem-
ocratic Republic and Myanmar may not be able to meet
the demand posed by the increasing number of heroin
users in some parts of Asia.
While seizures of morphine and heroin increased globally
in 2011, declines were noted in specific regions and coun-
tries, including Turkey and Western and Central Europe.
Cocaine
The global area under coca cultivation amounted to
155,600 ha in 2011, almost unchanged from a year earlier
but 14 per cent lower than in 2007 and 30 per cent less
than in 2000. Estimates of the amounts of cocaine manu-
factured, expressed in quantities of 100 per cent pure
cocaine, ranged from 776 to 1,051 tons in 2011, largely
unchanged from a year earlier. The world’s largest cocaine
seizures (not adjusted for purity) continue to be reported
from Colombia (200 tons) and the United States (94 tons).
However, there has been an indication in recent years that
the cocaine market has been shifting to several regions
which have not been associated previously with either traf-
ficking or use. Significant increases have been noted in Asia,
Oceania and Central and South America and the Carib-
bean. In Central America, intensified competition in traf-
ficking of cocaine has led to growing levels of violence.
Cocaine has long been perceived as a drug for the affluent.
There is some evidence which, though inconclusive,
suggests that this perception may not be entirely ground-
less, all other factors being equal. Nonetheless, the extent
of its use is not always led by the wallet. There are examples
of wealthy countries with low prevalence rates, and
vice-versa.
Arguably, parts of East and South-East Asia run a higher
risk of expansion of cocaine use (although from very low
levels). Seizures in Hong Kong, China, rose dramatically,
to almost 600 kg in 2010, and had exceeded 800 kg by
2011. This can be attributed to several factors, often linked
to the glamour associated with its use and the emergence
of more affluent sections of society. In the case of Latin
America, in contrast, most of the increase appears to be
linked to “spill-over” effects, as cocaine is widely available
and relatively cheap owing to the proximity to producing
countries.
In North America, seizures and prevalence have declined
considerably since 2006 (with the exception of a rebound
in seizures in 2011). Between 2006 and 2011, cocaine use
among the general population in the United States fell by
40 per cent, which is partly linked to less production in
Colombia, law enforcement intervention and inter-cartel
violence.
While, earlier, North America and Central/Western Europe
dominated the cocaine market, today they account for
approximately one half of users globally, a reflection of the
fact that use seems to have stabilized in Europe and
declined in North America.
In Oceania, on the other hand, cocaine seizures reached
new highs in 2010 and 2011 (1.9 and 1.8 tons, respec-
tively, up from 290 kg in 2009). The annual prevalence
rate for cocaine use in Australia for the population aged
14 years or older more than doubled from 1.0 per cent in
2004 to 2.1 per cent of the adult population in 2010; that
figure is higher than the European average and exceeds the
corresponding prevalence rates in the United States.
Amphetamine-type stimulants
There are signs that the market for amphetamine-type
stimulants (ATS) is expanding: seizures and consumption
levels are increasing, manufacture seems to be spreading
and new markets are developing.
The use of ATS, excluding “ecstasy”, remains widespread
globally, and appears to be increasing in most regions. In
2011, an estimated 0.7 per cent of the global population
aged 15-64, or 33.8 million people, had used ATS in the
preceding year. The prevalence of “ecstasy” in 2011 (19.4
million, or 0.4 per cent of the population) was lower than
in 2009.

WORLDDRUGREPORT2013
xiExecutive summary
While use is steady in the traditional markets of North
America and Oceania, there seems to be an increase in the
market in Asia’s developed economies, notably in East and
South-East Asia, and there is also an emerging market in
Africa, an assessment that is borne out by increasing diver-
sions of precursors, seizures and methamphetamine manu-
facture. The estimated annual prevalence of ATS use in
the region is higher than the global average.
At the global level, seizures have risen to a new high: 123
tons in 2011, a 66 per cent rise compared with 2010 (74
tons) and a doubling since 2005 (60 tons). Mexico clocked
the largest amount of methamphetamine seized, more than
doubling, from 13 tons to 31 tons, within the space of a
year, thus surpassing the United States for the first time.
Methamphetamine continues to be the mainstay of the
ATS business; it accounted for 71 per cent of global ATS
seizures in 2011. Methamphetamine pills remain the pre-
dominant ATS in East and South-East Asia where 122.8
million pills were seized in 2011, although this was a 9 per
cent decline compared with 2010 (134.4 million pills).
Seizures of crystalline methamphetamine, however,
increased to 8.8 tons, the highest level during the past five
years, indicating that the substance is an imminent threat.
Methamphetamine manufacture seems to be spreading as
well: new locations were uncovered, inter alia, in Poland
and the Russian Federation. There is also an indication of
increased manufacturing activity in Central America and
an increase in the influence of Mexican drug trafficking
organizations in the synthetic drugs market within the
region.
Figures for amphetamine seizures have also gone up, par-
ticularly in the Middle East, where the drug is available
largely in pill form, marketed as “captagon” pills and con-
sisting largely of amphetamine.
Europe and the United States reported almost the same
number of amphetamine laboratories (58 versus 57) in
2011, with the total number remaining fairly stable com-
pared with 2010.
While “ecstasy” use has been declining globally, it seems
to be increasing in Europe. In ascending order, Europe,
North America and Oceania remain the three regions with
a prevalence of “ecstasy” use that is above the global
average.
Cannabis
Providing a global picture of levels of cannabis cultivation
and production remains a difficult task: although cannabis
is produced in practically every country in the world, its
cultivation is largely localized and, more often than not,
feeds local markets.
Cannabis remains the most widely used illicit substance.
There was a minor increase in the prevalence of cannabis
users (180.6 million or 3.9 per cent of the population aged
15-64) as compared with previous estimates in 2009.
The areas of cannabis eradicated increased in the United
States, possibly indicating an increase in the area under
cultivation. Cultivation also seems to have gone up in the
Americas as a whole. In South America, reported cannabis
herb seizures rose by 46 per cent in 2011.
In Europe, seizures of cannabis herb increased, while sei-
zures of cannabis resin (“hashish”) went down. This may
indicate that domestically produced cannabis continues to
replace imported resin, mainly from Morocco. The pro-
duction of cannabis resin seems to have stabilized and even
declined in its main producing countries, i.e. Afghanistan
and Morocco.
Many countries in Africa reported seizures of cannabis
herb, with Nigeria reporting the largest quantities seized
in the region.
In Europe, cannabis is generally cultivated outdoors in
countries with favourable climatic conditions. In countries
with less favourable climatic conditions, such as Belgium
and the Netherlands, a larger number of indoor plants are
found. It is difficult to compile an accurate picture of cul-
tivation and eradication, as this varies widely across coun-
tries and climatic zones. Plant density fluctuates wildly,
depending on the cultivation method (indoor or outdoor)
and environmental factors.
New psychoactive substances
While new harmful substances have been emerging with
unfailing regularity on the drug scene, the international
drug control system is floundering, for the first time, under
the speed and creativity of the phenomenon known as new
psychoactive substances (NPS).
The number of NPS reported by Member States to
UNODC rose from 166 at the end of 2009 to 251 by
mid-2012, an increase of more than 50 per cent. For the
first time, the number of NPS actually exceeded the total
number of substances under international control (234).
NPS are substances of abuse, either in a pure form or a
preparation, that are not controlled by international drug
conventions, but which may pose a public health threat.
In this context, the term “new” does not necessarily refer
to new inventions but to substances that have newly
become available in specific markets. In general, NPS is
an umbrella term for unregulated (new) psychoactive sub-
stances or products intended to mimic the effects of con-
trolled drugs.
Member States have responded to this challenge using a
variety of methods within their legislative frameworks, by
attempting to put single substances or their analogues
under control.
It has generally been observed that, when a NPS is con-
trolled or scheduled, its use declines shortly thereafter,
which has a positive impact on health-related consequences
and deaths related to the substance, although the “substi-

xii WORLD DRUG REPORT 2013
tution effect” has inhibited any in-depth research on the
long-term impact of NPS scheduling. There are of course,
instances when scheduling or controlling a NPS has had
little or no impact. Generally, the following kinds of
impacts have been observed after the scheduling of a NPS:
(a) The substance remains on the market, but its use de-
clines immediately. Examples include mephedrone in
the United Kingdom of Great Britain and Northern
Ireland, BZP in New Zealand, “legal highs” in Poland,
mephedrone in Australia and MDPV in the United
States of America;
(b) Use of the substance declines after a longer interval,
maybe a year or more (e.g. ketamine in the United
States);
(c) Scheduling has little or no immediate impact on the
use of the substance, e.g. 3,4-methylenedioxy-N-
methylamphetamine (MDMA), commonly known as
“ecstasy”, in the United States and other countries.
Further, there are cases of NPS disappearing from the
market. This has also been the case with the majority of
the substances controlled under the 1961 Convention and
the 1971 Convention. Of the 234 substances currently
under international control, only a few dozen are still being
misused, and the bulk of the misuse is concentrated in a
dozen such substances.
It is obvious that legislations to control NPS are not a “one
size fits all” solution, and there are always exceptions to
the rule. However, a holistic approach which involves a
number of factors — prevention and treatment, legal
status, improving precursor controls and cracking down
on trafficking rings — has to be applied to tackle the
situation.
There is a lack of long-term data which would provide a
much-needed perspective: no sooner is one substance
scheduled, than another one replaces it, thus making it
difficult to study the long-term impact of a substance on
usage and its health effects.
The problem of NPS is a hydra-headed one in that manu-
facturers produce new variants to escape the new legal
frameworks that are constantly being developed to control
known substances. These substances include synthetic
and plant-based psychoactive substances, and have rapidly
spread in widely dispersed markets. Until mid-2012, the
majority of the identified NPS were synthetic cannabinoids
(23 per cent), phenethylamines (23 per cent) and synthetic
cathinones (18 per cent), followed by tryptamines (10 per
cent), plant-based substances (8 per cent) and piperazines
(5 per cent). The single most widespread substances were
JWH-018 and JWH-073 among the synthetic cannabi-
noids; mephedrone, MDPV and methylone among the
synthetic cathinones; and m-chlorophenylpiperazine
(mCPP), N-benzylpiperazine (BZP) and 1-(3-trifluoro-
methylphenyl)piperazine (TFMPP) among the pipera-
zines. Plant-based substances included mostly kratom, khat
and Salvia divinorum.
What makes NPS especially dangerous and problematic is
the general perception surrounding them. They have often
been marketed as “legal highs”, implying that they are safe
to consume and use, while the truth may be quite differ-
ent. In order to mislead the authorities, suppliers have also
marketed and advertised their products aggressively and
sold them under the names of relatively harmless everyday
products such as room fresheners, bath salts, herbal
incenses and even plant fertilizers.
Countries in nearly all regions have reported the emergence
of NPS. The 2008-2012 period in particular saw the emer-
gence of synthetic cannabinoids and synthetic cathinones,
while the number of countries reporting new phenethyl-
amines, ketamine and piperazines declined (as compared
with the period prior to 2008).
Origin and manufacture
While most widespread in Europe and North America,
NPS seem to originate nowadays primarily in Asia (East
and South Asia), notably in countries known for their
advanced chemical and pharmaceutical industries. Domes-
tic manufacture has also been reported by countries in
Europe, the Americas and Asia. Nonetheless, the overall
pattern is one of transregional trafficking which deviates
from the clandestine manufacture of controlled psycho-
tropic substances such as ATS, which typically occurs
within the same region as where the consumers are located.
Role of technology
The Internet seems to play an important role in the busi-
ness of NPS: 88 per cent of countries responding to a
UNODC survey said that the Internet served as a key
source for the supply in their markets. At the same time,
a Eurobarometer survey found that just 7 per cent of young
consumers of NPS in Europe (age 15-24) used the Internet
to actually purchase such substances, indicating that, while
the import and wholesale business in such substances may
be increasingly conducted via the Internet, the end con-
sumer still retains a preference for more traditional retail
and distribution channels.
Spread of new psychoactive
substances at the regional level
With its early warning system, comprising 27 European
Union countries and Croatia, Norway and Turkey, Europe
has the most advanced regional system in place to deal with
emerging NPS. Through the early warning system, formal
notification was provided for a total of 236 new substances
during the 2005-2012 period, equivalent to more than 90
per cent of all substances found globally and reported to
UNODC (251). The number of identified NPS in the
European Union rose from 14 in 2005 to 236 by the end
of 2012.
NPS seem to constitute a significant market segment
already. Close to 5 per cent of people aged 15-24 have
already experimented with NPS in the European Union,

WORLDDRUGREPORT2013
xiiiExecutive summary
which is equivalent to one-fifth of the numbers who have
tried cannabis and close to around half of the number who
have used drugs other than cannabis. While cannabis use
has clearly declined among adolescents and young people
in Europe over the past decade, and the use of drugs other
than cannabis has remained largely stable, the use of NPS
has gone up.
Within Europe, Eurobarometer data for 2011 suggest that
five countries account for almost three-quarters of all users
of NPS: United Kingdom (23 per cent of the European
Union total), followed by Poland (17 per cent), France (14
per cent), Germany (12 per cent) and Spain (8 per cent).
The United Kingdom is also the country that identified
the most NPS in the European Union (30 per cent of the
total during the 2005-2010 period).
The United States identified the largest number of NPS
worldwide: for 2012 as a whole, a total of 158 NPS were
identified, i.e. twice as many as in the European Union
(73). The most frequently reported substances were
synthetic cannabinoids (51 in 2012, up from 2 in 2009)
and synthetic cathinones (31 in 2012, up from 4 in 2009).
Both have a serious negative impact on health. Excluding
cannabis, use of NPS among students is more widespread
than the use of any other drug, owing primarily to syn-
thetic cannabinoids as contained in Spice or similar herbal
mixtures. Use of NPS among youth in the United States
appears to be more than twice as widespread as in the
European Union.
In Canada, authorities identified 59 NPS over the first two
quarters of 2012, i.e. almost as many as in the United
States. Most of the substances were synthetic cathinones
(18), synthetic cannabinoids (16) and phenethylamines
(11). In a national school survey, widespread use was
reported among tenth-grade students for Salvia divinorum
(lifetime prevalence of 5.8 per cent), jimson weed or
Datura (2.6 per cent), a hallucinogenic plant, and ketamine
(1.6 per cent).
NPS are also making inroads in the countries of Latin
America, even though, generally speaking, levels of misuse
of such substances in the region are lower than in North
America or Europe. Reported substances included keta-
mine and plant-based substances, notably Salvia divino-
rum, followed by piperazines, synthetic cathinones,
phenethylamines and, to a lesser extent, synthetic cannabi-
noids. Brazil also reported the emergence of mephedrone
and of DMMA (a phenethylamine) in its market; Chile
reported the emergence of Salvia divinorum and
tryptamine; Costa Rica reported the emergence of BZP
and TFMPP, two piperazines.
For many years, New Zealand has played a key role in the
market for piperazines, notably BZP. A large number of
NPS are also found in Australia, similar to the situation in
Europe and North America. Overall, 44 NPS were identi-
fied during the first two quarters of 2012 in the Oceania
region, equivalent to one quarter of all such substances
identified worldwide. Australia identified 33 NPS during
the first two quarters of 2012, led by synthetic cathinones
(13) and phenethylamines (8).
According to the UNODC survey undertaken in 2012,
the second-largest number of countries reporting the emer-
gence of NPS was in Asia. The emergence of such sub-
stances was reported from a number of countries and areas,
mostly in East and South-East Asia (Brunei Darussalam;
China; Hong Kong, China; Indonesia; Japan; Philippines;
Singapore; Thailand; Viet Nam), as well as in the Middle
East (Bahrain, Israel, Jordan, Oman, Saudi Arabia and
United Arab Emirates).
Hong Kong, China, reported the emergence of a number
of synthetic cannabinoids (such as JWH-018) and synthetic
cathinones (4-methylethcathinone and butylone). Indone-
sia informed UNODC of the emergence of BZP. Singapore
saw the emergence of a number of synthetic cannabinoids
(including JWH-018) and synthetic cathinones
(3-fluromethcathinone and 4-methylecathinone). Oman
witnessed the emergence of synthetic cannabinoids (JWH-
018). Japan reported the emergence of phenethylamines,
synthetic cathinones, piperazines, ketamine, synthetic can-
nabinoids and plant-based substances.
The two main NPS in Asia in terms of consumption are
ketamine and kratom, mostly affecting the countries of
East and South-East Asia. Ketamine pills have been sold
for several years as a substitute for “ecstasy” (and sometimes
even as “ecstasy”). In addition, large-scale traditional con-
sumption of khat is present in Western Asia, notably in
Yemen.
In total, 7 African countries (Angola, Cape Verde, Egypt,
Ghana, South Africa, Togo and Zimbabwe) reported the
emergence of NPS to UNODC. Egypt reported not only
the emergence of plant-based substances (Salvia divinorum)
but also the emergence of synthetic cannabinoids, keta-
mine, piperazines (BZP) and other substances (2-diphe-
nylmethylpiperidine (2-DPMP) and 4-benzylpiperidine).
Nonetheless, the overall problems related to the production
and consumption of NPS appear to be less pronounced
in Africa. There are, however, a number of traditionally
used substances (such as khat or ibogaine) that fall under
the category of NPS and that, in terms of their spread,
may cause serious health problems and other social
consequences.
The road ahead
Scheduling or controlling a substance is a lengthy — and
costly — process, especially as it is the authorities who bear
the onus of proof. Additionally, controlling an ever-larger
number of substances, affecting police, customs, forensic
laboratories, import/export authorities and the health
authorities, among others, may stretch some Member
States beyond their capacities.
Alternative systems, such as the establishment of “early
warning systems” for NPS, “emergency scheduling”, “ana-

xiv WORLD DRUG REPORT 2013
logue scheduling”, “generic scheduling”, application of the
“medicines law” and other creative approaches, all have
their pros and cons. Most have improved the situation and
have taught valuable lessons in planning for future control
regimes. However, what is missing is coordination at the
global level so that drug dealers cannot simply exploit loop-
holes, both within regions and even within countries.
The establishment of a global early warning system is
needed to inform Member States of emerging substances
and to support them in their response to this complex and
changing phenomenon.1 While the international drug con-
trol conventions offer the possibility of scheduling new
substances, the sheer rapidity of emerging NPS makes this
a very challenging undertaking. What is needed is an
understanding and sharing of methods and lessons learned
in regional responses to the situation involving NPS before
exploring the setting up of a global response to the
problem.
1 In its resolution 56/4 of 15 March 2013, the Commission on Narcotic
Drugs encouraged the United Nations Office on Drugs and Crime
“to share and exchange ideas, efforts, good practices and experiences
in adopting effective responses to address the unique challenges posed
by new psychoactive substances, which may include, among other
national responses, new laws, regulations and restrictions”.

WORLDDRUGREPORT2013
1
1RECENT STATISTICS AND TREND ANALYSIS
OF ILLICIT DRUG MARKETS
A. EXTENT OF ILLICIT DRUG USE
AND HEALTH CONSEQUENCES
Extent of drug use
In 2011, between 167 and 315 million people aged 15–64
were estimated to have used an illicit substance in the pre-
ceding year. This corresponds to between 3.6 and 6.9 per
cent of the adult population. The prevalence of illicit drug
use and the numbers of problem drug users — those with
drug use disorders or dependence – have remained stable.1
Since 2009, the prevalence of cannabis, opioids, and opi-
ates use has gone up, while the prevalence of use of cocaine,
amphetamine-type stimulants and “ecstasy”-group sub-
stances appears to have followed a declining trend between
2009 and 2011.2 Nevertheless, since 2008 there has been
an overall 18 per cent increase in the estimated total
number of people who had used an illicit substance in the
preceding year, which to some extent reflects both an
increase in the global population and a slight increase in
the prevalence of illicit drug use. A series of maps are pre-
sented in Annex I showing the prevalence of drug use
among the population aged 15-64 for cannabis, ampheta-
mies, opioids, opiates, cocaine and ecstasy. In addition, a
table is included providing estimates of the prevalence and
total number of users for each drug type at the global,
regional and subregional levels.
Cannabis
Cannabis use has increased globally, particularly in Asia
since 2009. Although epidemiological data is not available,
1 The number of problem drug users is driven mainly by the estimated
number of cocaine and opiate users and therefore reflects the overall
stable trends in the use of those drugs.
experts from the region report a perceived increase in use.
The regions with a prevalence of cannabis use that is higher
than the global average continue to be West and Central
Africa (12.4 per cent), Oceania (essentially Australia and
New Zealand, 10.9 per cent), North America (10.7 per
cent) and Western and Central Europe (7.6 per cent). Can-
nabis use in North America and in most parts of Western
and Central Europe is considered to be stable or
declining.
2 Changes in the prevalence of different drugs may be an artefact owing
to revised estimates within regions and subregions that may impact the
global prevalence of the drugs.
Fig. 1. Trends in drug use, 2006-2011
Fig. 2. Trends in the prevalence of different
drugs, 2009-2011
80
85
90
95
100
105
110
115
120
2009 2010 2011
Cannabis Opiates
Cocaine Amphetamines
Ecstasy-group Opioids
172
155 149 153
167
250 250
272
300
315
18 16 15 16 16
38 39 39 39
211 203 210
226
240
208
38
4.0%
3.5% 3.4% 3.4% 3.6%
5.8% 5.7%
6.2%
6.7% 6.9%
0.4% 0.4% 0.3% 0.3% 0.3%
5.2%5.0%4.9% 4.9%
4.6% 4.8%
0.9% 0.9% 0.9% 0.9% 0.9%
-
50
100
150
200
250
300
350
2006
2007
2008
2009
2010
2011
2006
2007
2008
2009
2010
2011
Numberofdrugusers
(millions)
0%
1%
2%
3%
4%
5%
6%
7%
8%
Annualprevalenceofpopulationage
15-64(percentage)
Prevalence of illicit drug use in %
Prevalence of problem drug use in %
No. of illicit drug users
No of problem drug users

1. RECENT STATISTICS AND TREND ANALYSIS OF ILLICIT DRUG MARKETS2
Use of ATS, excluding “ecstasy”, remains widespread glob-
ally, and appears to be increasing. Although prevalence
estimates are not available from Asia and Africa, experts
from these regions continue to report a perceived increase
in the use of ATS. While the use of ATS was already a
problem in East and South-East Asia, there are reports of
increasing diversion of precursor chemicals, as well as
increased seizures and manufacture of methamphetamine,
combined with an increase in its use. Current data from
the drug use survey in Pakistan, for instance supports this
assessment. Use of ATS is emerging in Pakistan, with a
reported annual prevalence of 0.1 per cent among the gen-
eral population.3 High levels of ATS use are reported in
Oceania (2.1 per cent in Australia and New Zealand), Cen-
tral and North America (1.3 per cent each) and Africa (0.9
per cent), while the estimated annual prevalence of ATS
use in Asia (0.7 per cent) is comparable with the global
average.
Opioids
The use of opioids (heroin, opium and prescription opi-
oids) has increased in Asia since 2009, particularly in East,
South-East, Central and South-West Asia. While reliable
data do not exist for most parts of Africa, experts report
an increase in the use of opioids there. North America 3.9
per cent), Oceania (3.0 per cent), the Near and Middle
East/South-West Asia (1.9 per cent) and East and South-
Eastern Europe (1.2 per cent) show a prevalence of opioid
use that is higher than the global average. The use of opi-
ates (heroin and opium) has remained stable in some
regions, nevertheless, a high prevalence is reported in the
Near and Middle East/South-West Asia (1.2 per cent),
primarily in Afghanistan, Iran (Islamic Republic of) and
Pakistan, as well as Central Asia (0.8 per cent), Eastern
and South-Eastern Europe (0.8 per cent), North America
(0.5 per cent) and West and Central Africa (0.4 per cent).
Cocaine
The two major markets for cocaine, North America and
Western and Central Europe, registered a decrease in
cocaine use between 2010 and 2011, with annual preva-
lence among the adult population in Western and Central
Europe decreasing from 1.3 per cent in 2010 to 1.2 per
cent in 2011, and from 1.6 per cent to 1.5 per cent in
North America. While cocaine use in many South Ameri-
can countries has decreased or remained stable, there has
been a substantial increase in Brazil that is obvious enough
to be reflected in the regional prevalence rate for 2011.
Australia has also reported an increase in cocaine use.
3 United Nations Office on Drugs and Crime and Pakistan, Ministry
of Narcotics Control, “Drug use in Pakistan 2013: technical summary
report” (March 2013).
“Ecstasy”
Overall, use of “ecstasy” (i.e., methylenedioxymetham-
phetamine (MDMA)) has been declining, although it
seems to be increasing in Europe. The three regions with
a high prevalence of “ecstasy” use continue to be Oceania
(2.9 per cent), North America (0.9 per cent) and Europe
(0.7 per cent). Use continues to be associated with young
people and recreational and nightlife settings in urban cen-
tres. For example, of the 2 million past-year users of
“ecstasy” in Europe, 1.5 million were between 15 and 34
years of age.4
Non-medical use of prescription
drugs
While global estimates of non-medical use of prescription
drugs are not available, such use remains a major public
health concern. The misuse or non-medical use of tran-
quillizers and sedatives such as benzodiazepines and bar-
biturates remains high and, at times, higher than that of
many illicit substances. Along with the single use of tran-
quillizers (e.g. benzodiazepines), their use is commonly
observed among polydrug users, especially among users of
heroin who use benzodiazepines to enhance its effects, as
well as those on methadone medication.5 Benzodiazepines
are also often cited among the other substances reported
in both fatal and non-fatal overdose cases among opioid
users.6
The misuse of tranquillizers and sedatives is spread across
all regions. Among the 103 countries that have provided
information on the non-medical use of such substances
through the annual report questionnaire, nearly 60 per
cent ranked them as among the three most misused types
of substances in their country, while nearly 15 per cent of
countries7 ranked them as the most commonly used sub-
stances. In countries with data on the annual prevalence
of tranquillizers, prevalence varied between 0.4 per cent in
England and Wales and 12.9 per cent in Estonia.
The misuse of prescription opioids is also increasingly
being reported from different regions. Tramadol is an
opioid painkiller that is not under international control,
whose misuse is being reported from many countries in
Africa, the Middle East, Asia (including China) and the
4 European Monitoring Centre for Drugs and Drug Addiction, Annual
Report 2012: The State of the Drugs Problem in Europe (Luxembourg,
Publications Office of the European Union, 2012).
5 M. Backmund and others, “Co-consumption of benzodiazepines
in heroin users, methadone- substituted and codeine-substituted
patients”, Journal of Addictive Diseases, vol. 24, No. 4 (2006), pp.
17-29.
6 P. Oliver, R. Forrest and J. Keen, “Benzodiazepines and cocaine as risk
factors in fatal opioid overdoses” (London, National Treatment Agency
for Substance Misuse, April 2007.
7 Algeria, Bulgaria, Burkina Faso, Estonia, Honduras, Hungary, Italy,
Netherlands, Nicaragua, Peru, Poland, Romania, Serbia and Venezuela
(Bolivarian Republic of).

A. Extent of illicit drug use and health consequences
WORLDDRUGREPORT2013
3
Pacific Islands. In many countries, the most common
sources of prescription drugs are friends and relatives who
have been prescribed them by a physician.8 The sale of
counterfeit prescription drugs through black markets and
loosely controlled pharmacies in developing countries is
quite common, while unregulated Internet pharmacies are
fast becoming a common source.9
New psychoactive substances
NPS have become a major concern, not only because of
their increasing use but also because of the lack of scientific
research and understanding of their adverse effects (see
chapter 2).
Apart from these new substances, several countries10 have
also reported the misuse of cough medicines containing
codeine and simple cough suppressants such as dex-
tromethorphan. Dextromethorphan was included for pre-
review by the Expert Committee on Drug Dependence at
its thirty-fifth meeting, in 2012.11 The misuse of dex-
tromethorphan is quite common among adolescents and
8 United Nations Office on Drugs and Crime, The Non-medical Use of
Prescription Drugs: Policy Direction Issues (Vienna, 2011).
9 Report of the International Narcotics Control Board for 2012 (United
Nations publication, Sales No. E.13.XI.1).
10 Including Australia, Bangladesh, Canada, Germany, Indonesia, Nige-
ria, Pakistan, the Republic of Korea, the United States, Sweden and
Hong Kong, China.
11 World Health Organization, “Dextromethorphan: pre-review report”,
prepared for the thirty-fifth meeting of the Expert Committee on
Drug Dependence, held in Hammamet, Tunisia, from 4 to 8 June
2012.
young adults. For instance, in the United States of Amer-
ica, the annual prevalence of non-medical use of cough
syrups among students in eighth, tenth and twelfth grades
was reported as 2.7 per cent, 5.5 per cent and 5.3 per
cent, respectively.12 When cough syrup containing dex-
tromethorphan is taken in quantities higher than the rec-
ommended dosages, the dextromethorphan acts as a
“dissociative hallucinogen”, producing effects similar to
those created by other hallucinogens such as ketamine and
phencyclidine.13
Extent of health consequences of
drug use
Injecting drug use
Updating the previous global estimates, the United Nations
Office on Drugs and Crime (UNODC) estimates that in
2011 a total of 14.0 million (range: 11.2 million to 22.0
million) people injected drugs worldwide, which corre-
sponds to 0.31 per cent (range: 0.24-0.48 per cent) of the
population aged 15-64.14 The current global estimates are
lower than the previous ones of 15.9 million people, and
primarily reflect the fact that many countries have revised
their earlier estimates downward, based on behavioural
surveillance data. However, many countries have also
reported an increase in the prevalence of injecting drug use
and in the number of people who inject drugs.
Changes over time in national, regional and global esti-
mates of injecting drug use may result from a number of
factors, such as improvements in the methodology or cov-
erage of behavioural surveillance (e.g., Georgia, Italy and
South Africa), additional countries undertaking behav-
ioural surveillance for the first time (Kenya and Seychelles)
or changes in patterns of drug use, including injecting drug
use (Australia and Brazil). Such factors have contributed
to the overall reduced global estimates of people who inject
drugs. Notable increases in the estimated number of people
who inject drugs have been reported from Pakistan, the
Russian Federation and Viet Nam, while countries report-
ing a considerable reduction include Brazil, Indonesia,
South Africa, Thailand and the United States.
At a regional level, a high prevalence of injecting drug use
is found in Eastern and South-Eastern Europe (1.3 per
cent of the population aged 15-64), where the percentage
of people who inject drugs is four times greater than the
global average and which alone accounts for 21 per cent
of the total number of people who inject drugs globally.
A high prevalence rate for injecting drug use is also noted
in Central Asia (1.3 per cent), which has a rate of more
12 Lloyd D. Johnston and others, Monitoring the Future: National Results
on Adolescent Drug Use—Overview of Key Findings, 2011 (Ann Arbor,
Michigan, University of Michigan, Institute for Social Research,
2012).
13 World Health Organization, “Dextromethorphan: pre-review report”.
14 This estimate is based on information provided by 83 countries that
together account for 81 per cent of the global population aged 15-64.
Fig. 3. Annual prevalence of non medical use
of tranquillizers and sedatives among
the general population in high-
prevalence countries
Source: United Nations Office on Drugs and Crime, data from the
annual report questionnaire (2007-2011).
1.9
2.1
2.3
2.6
3.3
4.1
4.3
5.1
5.3
6.7
6.9
7.8
7.8
9.1
10.0
10.4
11.9
12.0
12.6
12.9
0.0 2.0 4.0 6.0 8.010.0 12.014.0
Australia
Venezuela (Bolivarian Republic of)
Finland
United States of America
Poland
Nicaragua
Germany
Turkey
Netherlands
Hungary
Bolivia (Plurinational State of)
El Salvador
Mexico
Canada
Former Yugoslav Rep. of Macedonia
Italy
Lithuania
Portugal
Norway
Estonia

Table 1. Estimated number and prevalence of people who inject drugs among the general
population aged 15-64, 2011
Sources: United Nations Office on Drugs and Crime, data from the annual report questionnaire; progress reports of the Joint United
Nations Programme on HIV/AIDS (UNAIDS) on the global AIDS response (various years); the Reference Group to the United Nations on
HIV and Injecting Drug Use; estimates based on United Nations Office on Drugs and Crime data; and national Government reports.
Region Subregion Injecting drug users
Estimated number Prevalence (%)
Low Best High Low Best High
AFRICA 304,925 997,574 6,608,038 0.05 0.17 1.12
AMERICA 2,908,787 3,427,561 4,019,041 0.47 0.55 0.64
North America 1,935,144 2,006,470 2,101,572 0.63 0.65 0.68
Latin America and the Caribbean 973,643 1,421,091 1,917,468 0.31 0.45 0.61
ASIA 4,328,212 5,692,005 7,031,647 0.16 0.20 0.25
Central Asia and Transcaucasia 659,582 699,191 758,421 1.25 1.33 1.44
East and South-East Asia 2,959,863 3,786,472 4,677,484 0.19 0.25 0.30
Near and Middle East/
South-West Asia
462,269 952,948 1,334,013 0.17 0.36 0.50
South Asia 246,498 253,394 261,729 0.03 0.03 0.03
EUROPE 3,553,859 3,777,948 4,156,492 0.64 0.68 0.75
Eastern/South-Eastern Europe 2,821,599 2,907,484 2,987,155 1.23 1.26 1.30
Western/Central Europe 732,260 870,464 1,169,337 0.23 0.27 0.36
OCEANIA 118,628 128,005 158,919 0.49 0.53 0.66
GLOBAL 11,214,411 14,023,092 21,974,136 0.24 0.31 0.48
Fig. 4. Changes in the prevalence of people
who inject drugs use among the adult
population aged 15-64, 2008-2011
Source: UNODC and Reference Group to the United Nations on
HIV and Injecting Drug Use.
Note: A ratio of 1.0 indicates no change in the estimates. Chart shows
countries where the prevalence of injecting drug use has at least either
doubled (ratio is 2.0 or greater) or halved (ratio is 0.5 or less). Changes in
prevalence may reflect improved reporting on prevalence estimates, as well
as changes in injecting behaviour.
Moldova (Republic of)
Afghanistan
Pakistan
Viet Nam
Chile
Portugal
Italy
Australia
Kenya
Georgia
Indonesia
South Africa
Thailand
Spain
Belarus
0.1 1.0 10.0 100.0
Increase in prevalenceDecrease in prevalence
Fig. 5. Changes in the number of people who
inject drugs among the adult
population aged 15-64, 2008-2011
Note: Changes may reflect improved reporting on prevalence estimates, as
well as changes in injecting behaviour.
Brazil
South Africa
Italy
Indonesia
Thailand
Kenya
Australia
Georgia
Spain
Malaysia
Ukraine
Nepal
Kazakhstan
Afghanistan
Argentina
Belarus
Viet Nam
Pakistan
Russian
Federation
United
States
-600,000 -400,000 -200,000 0 200,000 400,000 600,000
Increase in numberDecrease in number

WORLDDRUGREPORT2013
5
than four times the global average. Injecting drug use also
remains a serious public health concern in a number of
countries in East and South-East Asia, with the region
accounting for 27 per cent of the global total. South Asia
has the lowest level of injecting drug use (0.03 per cent,
mostly as a result of the low prevalence rate reported in
India), considerably lower than that of any other region.
Countries and areas with the highest rates of injecting drug
use – more than 3.5 times the global average — are Azer-
baijan (5.2 per cent), Seychelles (2.3 per cent), the Russian
Federation (2.3 per cent), Estonia (1.5 per cent), Georgia
(1.3 per cent), Canada (1.3 per cent), the Republic of
Moldova (1.2 per cent), Puerto Rico (1.15 per cent), Latvia
(1.15 per cent) and Belarus (1.11 per cent). China, the
Russian Federation and the United States are the countries
with the largest numbers of people who inject drugs. Com-
bined, they account for an estimated 46 per cent, or nearly
one in two, people who inject drugs globally.
HIV among people who inject drugs
Of the estimated 14.0 million (range: 11.2 million to 22.0
million) people who inject drugs worldwide, UNODC
estimates that 1.6 million (range: 1.2 million to 3.9 mil-
lion) are living with HIV. That represents a global preva-
lence of HIV of 11.5 per cent among people who inject
drugs.15
15 The estimate is based on the reporting of the HIV prevalence rate
among people who inject drugs from 106 countries.
Along with the estimates of the total number of people
who inject drugs, the global total and prevalence rates of
people who inject drugs living with HIV for 2011 is also
lower than the estimated 3 million (18.9 per cent preva-
lence among people who inject drugs) previously presented
by the Reference Group to the United Nations on HIV
and Injecting Drug Use for 2008. These reduced estimates
are in large part a result of the availability of more reliable
information on HIV prevalence among people who inject
drugs.
The total number of people who inject drugs and are living
with HIV in a particular region is a function of three vari-
ables: the prevalence of HIV among people who inject
drugs; the prevalence of people who inject drugs; and the
total population in the region aged 15-64. These variables
are depicted in figure 8.
There is relatively little regional variation in the prevalence
of HIV among people who inject drugs, especially in com-
parison with the variation observed in the prevalence of
people who inject drugs. The one exception is Oceania
(based on data from Australia and New Zealand), where
the prevalence of HIV among people who inject drugs is
noticeably lower than in all other regions. Overall, the
Russian Federation, the United States and China account
for one half (46 per cent) of the global number of people
who inject drugs that are living with HIV (21 per cent, 15
per cent and 10 per cent, respectively).
Table 2. People who inject drugs living with HIV, 2011
Source: United Nations Office on Drugs and Crime, data from the annual report questionnaire; progress reports of the Joint United
Region Subregion HIV among injecting drug users
Estimated number Prevalence (%)
Best estimate
Low Best High
AFRICA 36,506 117,502 1,837,542 11.8
AMERICA 222,053 369,445 560,134 10.8
North America 159,836 270,749 383,041 13.5
Latin America and the Caribbean 62,217 98,696 177,093 6.9
ASIA 440,559 637,271 928,476 11.2
Central Asia and Transcaucasia 54,858 59,193 71,352 8.5
East and South-East Asia 256,396 328,101 519,982 8.7
Near and Middle East/South-West Asia 108,539 228,765 315,430 24.0
South Asia 20,767 21,212 21,712 8.4
EUROPE 466,243 492,054 532,304 13.0
Eastern/South-Eastern Europe 419,715 433,836 448,183 14.9
Western/Central Europe 46,528 58,217 84,120 6.7
OCEANIA 1,095 1,308 1,635 1.0
GLOBAL 1,166,456 1,617,580 3,860,091 11.5

Map 1. Prevalence of people who inject drugs among the general population aged 15-64, 2011 or
latest year available
Ç
ÇÇÇÇÇ
Ç
ÇÇ
Ç
Ç
Ç
Ç
Ç
HIV among IDU
0.00 - 1.50
1.50 - 5.92
5.92 - 9.10
9.10 - 15.07
15.07 - 52.42
No data provided
Ç
ÇÇÇÇÇ
Ç
ÇÇ
Ç
Ç
Ç
ÇÇ
IDU
0.01 - 0.08
0.08 - 0.19
0.19 - 0.37
0.37 - 0.73
0.73 - 5.21
No data provided
Map 2. Prevalence of HIV among people who inject drugs, 2011 or latest year available
Source: United Nations Office on Drugs and Crime, data from the annual report questionnaire; progress reports of the Joint United
Note: The boundaries shown on this map do not imply official endorsement or acceptance by the United Nations. Dashed lines represent undetermined
boundaries. Dotted line represents approximately the Line of Control in Jammu and Kashmir agreed upon by India and Pakistan. The final status of Jammu
and Kashmir has not yet been agreed upon by the parties. The final boundary between the Sudan and South Sudan has not yet been determined.

WORLDDRUGREPORT2013
7
Fig. 6. Changes in the prevalence of HIV
among people who inject drugs,
2008-2011
Note: Ratio of latest to previous Reference Group estimates of the preva-
lence of HIV among injecting drug users. A ratio of 1.0 indicates no change
in the estimates. Chart shows countries where the prevalence of HIV
among injecting drug users has either at least doubled (ratio is 2.0 or
greater) or halved (ratio is 0.5 or less). Changes may reflect improved
reporting on prevalence estimates as well as changes in injecting behaviour
and HIV infection.
Bulgaria
Finland
Romania
Tunisia
Greece
Belarus
Czech Republic
Philippines
Mexico
Afghanistan
Canada
Turkey
Oman
Brazil
Nepal
Netherlands
Argentina
New Zealand
Austria
Poland
Israel
Russian Federation
Viet Nam
Kazakhstan
Kenya
Georgia
Egypt
Colombia
Pakistan
Bangladesh
Libya
Lithuania
Slovenia
Switzerland
0.1 1.0 10.0 100.0
Increase in prevalenceDecrease in prevalence
Fig. 7. Changes in the number of people who
inject drugs living with HIV from 2008
to 2011
Note: Calculation based on 2011 adult population. Changes may reflect
improved reporting on prevalence estimates, as well as changes in injecting
behaviour and HIV infection.
Brazil
Russian
Federation
China
Ukraine
Thailand
Indonesia
United States
Kenya
Spain
South Africa
Argentina
Canada
Italy
Myanmar
Azerbaijan
Malaysia
Nepal
Belarus
Pakistan
-500,000 -400,000 -300,000 -200,000 -100,000 0 100,000 200,000
Increase in numberDecrease in number
Fig. 8. Prevalence rates for people who inject drugs and prevalence and number of people who
inject drugs living with HIV (by region)
Source: United Nations Office on Drugs and Crime, data from the annual report questionnaire and national Government reports.
Note: IDUs stands for injecting drug users.
Oceania
Western/ Central Europe
Eastern/ South-Eastern Europe
South Asia
Near and Middle East /
South-West Asia
East and South-East Asia
Central Asia and Transcaucasia
latin America and the Carribbean
North America
Africa
Population (aged 15-64)
(1,000's)
Prevalence (%) IDUs
among population
aged 15-64
0.17
0.65
0.45
1.33
0.25
0.36
0.03
0.27
1.26
0.53
Prevalence (%) HIV
among IDUs
11.8
13.5
6.9
8.5
8.7
24.0
14.9
6.7
8.4
1.0
Number of IDUs living
with HIV
(1,000's)
117.5
270.7
98.7
59.2
328.1
228.8
21.2
433.8
58.2
1.3Oceania
Western/ Central Europe
Eastern/ South-Eastern Europe
South Asia
Near and Middle East /
South-West Asia
East and South-East Asia
Central Asia and Transcaucasia
latin America and the Carribbean
North America
Africa

The region with the highest prevalence of HIV among
people who inject drugs is the Near and Middle East/
South-West Asia (24 per cent). This is driven primarily by
high rates of HIV among people who inject drugs in Paki-
stan (37.0 per cent) and Iran (Islamic Republic of) (15.1
per cent). Almost 30 per cent of the global population who
inject drugs and are living with HIV, however, are in East-
ern and South-Eastern Europe. Similar to Pakistan,
Ukraine has a large population of people who inject drugs,
with a very high prevalence of HIV (22.0 per cent).
International data show that rates of HIV prevalence are
much higher among prison inmates than the general popu-
lation.16 From the annual report questionnaire, the
reported prevalence rate of HIV in the prison population
varies from 0.2 per cent in Hungary to 15 per cent in Kyr-
gyzstan; these rates are between 2 and 37 times higher than
in the general adult population.
Hepatitis among people who inject
drugs
Another major global public health concern is hepatitis C,
which can lead to liver diseases such as cirrhosis and cancer.
Infection with the hepatitis C virus (HCV) is highly preva-
lent among people who inject drugs. UNODC estimates
that the global prevalence of HCV among people who
16 United Nations Office on Drugs and Crime, International Labour
Organization, United Nations Development Programme and World
Health Organization, policy brief on “HIV prevention, treatment and
care in prisons and other closed settings: a comprehensive package of
interventions” (2012).
inject drugs is 51.0 per cent, meaning that 7.2 million
people who inject drugs were living with HCV in 2011.17
The largest numbers of people who inject drugs and are
living with HCV are found in East and South-East Asia,
Eastern and South-Eastern Europe and North America.
The highest HCV prevalence rates among people who
inject drugs in countries with predominantly large num-
bers of people who inject drugs (more than 100,000 to
help ensure that a stable prevalence can be determined) are
mostly located in North America and East and South-East
Asia: Mexico (96.0 per cent), Viet Nam (74.1 per cent),
United States (73.4 per cent), Canada (69.1 per cent),
Malaysia (67.1 per cent), China (67.0 per cent) and
Ukraine (67.0 per cent).
The global prevalence of the hepatitis B virus (HBV) in
2011 among people who inject drugs is estimated at 8.4
per cent, or 1.2 million people, based on reporting from
63 countries. The highest prevalence of HBV among
people who inject drugs is found in the Near and Middle
East/South West Asia (22.5 per cent) and Western and
Central Europe (19.2 per cent).
As is the case for other infectious diseases, such as tuber-
culosis and HIV, the prevalence of hepatitis and, in par-
ticular, hepatitis C, is very high among the prison
17 The estimate is based on reporting from 78 countries.
Fig. 9. Estimated number of people who inject drugs, and number of people who inject drugs living
with hepatitis B and hepatitis C
Source: United Nations Office on Drugs and Crime, data from the annual report questionnaire and national Government reports.
0.0
1.0
2.0
3.0
4.0
5.0
6.0
7.0
NorthAmerica
LatinAmerica
andtheCaribbean
CentralAsiaand
Transcaucasia
Eastand
South-EastAsia
Near
andMiddleEast/
South-WestAsia
SouthAsia
EasternandSouth-
EasternEurope
Western
andCentral
Europe
AFRICA AMERICAS ASIA EUROPE OCEANIA
Number(millions)
Number of people who inject drugs
Hepatitis C among people who inject drugs
Hepatitis B among people who inject drugs

WORLDDRUGREPORT2013
9
Fig. 10. Primary drug of concern for people in treatment, by region (2011 or latest year available)
Source: United Nations Office on Drugs and Crime, data from the annual report questionnaire, supplemented by national Government
reports.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
North
America
Latin
America and
the
Caribbean
Eastern and
South-
Eastern
Europe
Western and
Central
Europe
AFRICA AMERICAS ASIA EUROPE OCEANIA
Percentoftreatmentdemand
Cannabis Opioids
Cocaine Amphetamine-type stimulants
Tranquillizers and sedatives Hallucinogens
Solvents and inhalants Other
Drug treatment: costs and benefits
There are different treatment modalities available in different countries, and studies have shown that treatment interven-
tions can have great benefits. Long-term drug treatment may, on average, save money, and result in a host of other
benefits. Data demonstrate that the benefits of treatment vary according to the drug of choice and the severity of depend-
ence. In a meta-analysis of over 34 randomized controlled trials, cognitive behavioural therapy was found to have the
largest effect on cannabis dependence, followed by opioid dependence and polysubstance dependence.a Cognitive
behavioural therapy has also been shown to be effective against substance abuse occurring in tandem with suicidal
thoughts in adolescents.b Opiate substitution therapy has also proven to increase the probability of survival, owing to a
lower rate of suicide attempts, diminished likelihood of HIV transmission and reduced participation in crime. A com-
parison of involvement in criminal activity, pre- and post-treatment, shows a significant drop after therapy for a variety
of criminal behaviours. In a study of over 23,000 people who inject drugs, the incidence of HIV was 54 per cent lower
among those who had received methadone maintenance therapy compared with those who did not. Additional benefits
to society include lower rates of driving under the influence of drugs or alcohol, and higher employment among treated
users. In the United States, one year of methadone maintenance treatment for opioid dependence costs approximately
$4,700, whereas one year of imprisonment costs approximately $24,000. The weight of evidence shows enormous ben-
efits, both in dollars saved and improved quality of life.
a R. K. McHugh, B. A. Hearon and M. W. Otto, “Cognitive-behavioural therapy for substance use disorders”, Psychiatric Clinics of North America, vol. 33,
No. 3 (2010), pp. 511-525.
b C. Esposito-Smythers and others, “Treatment of co-occurring substance abuse and suicidality among adolescents: a randomized trial”, Journal of Con-
sulting and Clinical Psychology, vol. 79, No. 6 (2011), pp. 728-739.
Sources: United States, Department of Health and Human Services, National Institute on Drug Abuse, Principles of Drug Addiction
Treatment: A Research-based Guide, 3rd ed., NIH publication No. 12-4180 (2012); J. Kimber and others, “Survival and cessation in
injecting drug users: prospective observational study of outcomes and effect of opiate substitution treatment”, British Medical Journal,
vol. 341, No. 7764 (17 July 2010), p.135 L. Cottler and others, “Predictors of high rates of suicidal ideation among drug users”, Jour-
nal of Nervous and Mental Disease, vol. 193, No. 7 (2005), pp. 431-437; M. A. Ilgen and others, “Substance use-disorder treatment
and a decline in attempted suicide during and after treatment”, Journal of Studies on Alcohol and Drugs, vol. 68, No. 4 (2007), pp.
503-509; M. Jofre-Bonet and J. L. Sindelar, “Drug treatment as a crime fighting tool”, Journal of Mental Health Policy and Economics,
vol. 4, No. 4 (2001), pp. 175-178;
A. Healey and others, “Criminal outcomes and costs of treatment services for injecting and non-injecting heroin users: evidence from
a national prospective cohort survey”, Journal of Health Services Research and Policy, vol. 8, No. 3 (2003), pp. 134-141; I. Sheerin and
others, “Reduction in crime by drug users on a methadone maintenance therapy programme in New Zealand”, New Zealand Medical
Journal, vol. 117, No. 1190 (12 March 2004); G. J. MacArthur and others, “Opiate substitution therapy and HIV transmission in
people who inject drugs: systematic review and meta-analysis”, British Medical Journal, vol. 345, No. 7879 (20 October 2012); G.
D’Onofrio and others, “A brief intervention reduces hazardous and harmful drinking in emergency department patients”, Annals of
Emergency Medicine, vol. 60, No. 2 (2012), pp. 181-192; and M. Bilban, A. Kastelic and L. M. Zaletel-Kragelj, “Ability to work and
employability of patients in opioid substitution treatment programs in Slovenia”, Croatian Medical Journal, vol. 49, No. 6 (2008), pp.
842-852.

population: more than 10 per cent in most cases and up
to 42 per cent in Finland and 45 per cent in New
Zealand.
Problem drug use as reflected by the
demand for treatment
It is estimated that approximately one in six problem drug
users18 globally receives treatment for drug use disorders
or dependence each year. However, there is a greater than
six fold variation between the regions. Africa, in particular,
stands out, with only one in 18 problem drug users access-
ing treatment services, predominantly for treatment related
to cannabis use disorders. In Latin America and the Carib-
bean and Eastern and South-Eastern Europe, approxi-
mately one in 11 problem drug users accesses treatment
services, well below the global average. Conversely, in
North America, each year an estimated one in three prob-
lem drug users receives treatment interventions. To a cer-
tain extent, these regional differences reflect varying
reporting systems for treatment demand,19 but they also
undoubtedly demonstrate the wide disparity in the avail-
ability and accessibility of drug dependance treatment ser-
vices in different regions.
Drug-related deaths
Drug-related deaths show the extreme harm that can result
from drug use. These deaths are invariably premature,
occurring at a relatively younger age. For example, accord-
ing to the European Monitoring Centre for Drugs and
Drug Addiction (EMCDDA), the mean age for drug-
related deaths for countries in Europe varies from 26 to
18 Those who regularly use opiates, cocaine or amphetamines, are people
who inject drugs or are diagnosed with dependence or substance use
disorders.
19 Member States may report treatment episodes rather than persons
in treatment, include only inpatient services or provide data that is
geographically limited (e.g. for only the capital city).
44 years, and such deaths can largely be prevented.
UNODC estimates that there were between 102,000 and
247,000 drug-related deaths in 2011, corresponding to a
mortality rate of between 22.3 and 54.0 deaths per million
population aged 15-64. This represents between 0.54 per
cent and 1.3 per cent of mortality from all causes globally
among those aged 15-64.20 The extent of drug-related
deaths has essentially remained unchanged globally and
within regions.
Regional trends in drug use
Africa
Africa remains a region with minimal systematic informa-
tion available on either the extent of or patterns or trends
related to drug use. Nevertheless, estimates from Africa
indicate a high prevalence of cannabis use (7.5 per cent,
or nearly double the global average), which is particularly
high in West Africa. The use of ATS (0.9 per cent), cocaine
(0.4 per cent) and opiates (0.3 per cent) remains compa-
rable with the global average.
The use of opioids is perceived to be increasing signifi-
cantly in Africa, with experts in the region also reporting
an increase. Many countries also reported an increase in
use of cannabis, ATS and cocaine in 2011. Cocaine use in
particular is perceived to be increasing in the Western
coastal countries and is considered to be linked with the
trafficking of cocaine into and through the region. A recent
study in the Dakar region of Senegal indicated that, while
heroin use had declined since 2000, consumption of crack
20 According to World Population Prospects: The 2010 Revision (United
Nations, Department of Economic and Social Affairs), an average of
18.94 million deaths will occur each year for those aged 15-64 from
all causes of mortality during the period 2010-2015.
Table 3. Estimated number of drug-related deaths and mortality rates per million population aged
15-64 for 2011
Source: United Nations Office on Drugs and Crime, data from the annual reports questionnaire, the Inter-American Drug Abuse Control
Commission (CICAD) and the European Monitoring Centre for Drugs and Drug Addiction, Louisa Degenhardt and others, “Illicit drug
use”, in Comparative Quantification of Health Risks: Global and Regional Burden of Disease Attributable to Selected Major Risk Factors,
vol. 1, M. Ezaati and others, eds. (Geneva, World Health Organization, 2004). Data for Africa have been adjusted to reflect the 2011
population. The wide range in the estimates for Asia reflects the low level of reporting from countries in the region. The best estimate for
Asia is towards the upper end of the range, because a small number of highly populated countries report a relatively high mortality rate,
which produces a high regional average.
Region Number of drug-related deaths Mortality rate per million aged 15-64
Estimate Lower estimate Upper estimate Estimate Lower estimate Upper estimate
Africa 36,435 17,336 55,533 61.9 29.4 94.3
North America 47,813 47,813 47,813 155.8 155.8 155.8
Latin America and the Caribbean 4,756 3,613 8,097 15.0 11.4 25.6
Asia 104,116 16,125 118,443 37.3 5.8 42.4
Western and Central Europe 8,087 8,087 8,087 24.9 24.9 24.9
Eastern and South-Eastern Europe 7,382 7,382 7,382 32.1 32.1 32.1
Oceania 1,957 1,685 1,980 80.8 69.6 81.8
Global 210,546 102,040 247,336 45.9 22.3 54.0

WORLDDRUGREPORT2013
11
cocaine had increased, and that currently between 70 per
cent and 80 per cent of crack users were also using hero-
in.21 Similarly, heroin trafficking through the coastal
regions of East Africa is believed to have caused an increase
in heroin and injecting drug use. In a behavioural surveil-
lance study among people who inject drugs in Seychelles,
heroin was the most commonly injected substance; other
substances commonly used by injectors included cannabis
and alcohol.22 In Kenya, heroin was the primary drug used
by people who inject drugs, while polydrug use of cannabis
21 Gilles Raguin and others, “Drug use and HIV in West Africa: a
neglected epidemic”, Tropical Medicine and International Health, vol.
16, No. 9 (2011), pp. 1131-1133.
22 Seychelles, Ministry of Health, “Injecting drug use in the Seychelles,
2011: integrated biological and behavioural surveillance study, round
1” (2011).
and flunitrazepam was also commonly reported among
those injecting drugs.23
In Nigeria, cannabis remains the most commonly used
substance, but opioid use is also perceived to be increasing.
The misuse of prescription opioids such as pentazocine
and codeine-containing cough syrups is considered to be
particularly problematic.24 South Africa reported an
increase in the use of heroin, methamphetamine and meth-
cathinone, while cocaine use remained stable. Treatment
facilities across the country reported that heroin use was a
growing concern. Polydrug use was also reported as a
common phenomenon among drug users in treatment,
e.g. the use of cannabis and methaqualone among meth-
amphetamine users and methamphetamine among heroin
users, as was the use of benzodiazepines, narcotic analgesics
and codeine-containing preparations.25
In North Africa, recent information on drug use is avail-
able from Algeria and Morocco. While the overall preva-
lence of different drugs is low in Algeria (use of any illicit
drug was reported among 1.15 per cent of the adult popu-
lation), an increase in the misuse of cannabis and tran-
quilizers and sedatives has been reported, while the use of
opioids and ATS is considered stable. However, an increase
in injecting ATS was reported.26 In Morocco, use of can-
23 “Rapid situational assessment of HIV prevalence and related risky
behaviours among people who inject drugs in Nairobi and coast prov-
inces of Kenya”, in Most-At-Risk Populations: Unveiling New Evidence
for Accelerated Programming (Kenya, Ministry of Health, National
AIDS and STI Control Programme, March 2012).
24 Information provided by Nigeria in the annual report questionnaire
(2012).
25 Siphokazi Dada and others, “Monitoring alcohol and drug abuse
trends in South Africa (July 1996-June 2011): phase 30”, SACENDU
Research Brief, vol. 14, No. 2 (2011).
26 Information provided by Algeria and Morocco in the annual report
questionnaire (2012).
Fig. 11. Cumulative unweighted average of
perceived trends in drug use in Africa
by drug type
Source: United Nations Office on Drugs and Crime, data from the
annual report questionnaire.
Drug-related deaths in the United
Kingdom of Great Britain and
Northern Ireland
Within the United Kingdom, data from England and
Wales show that drug misusea was responsible for 10 per
cent of deaths from all causes for those aged 20-39 in
2011.b Heroin and morphine accounted for most of the
deaths, but between 2010 and 2011 the number of
deaths associated with these two drugs declined by 25
per cent, from 791 to 596. This decline might have been
associated with the heroin “drought” experienced in the
United Kingdom starting in 2010. However, over the
same time period, the number of deaths related to the
use of methadone, reportedly mixed with benzodiaz-
epines and/or alcohol, increased by 37 per cent, from
355 to 486.c A similar situation was observed in Scot-
land, where there was a 19 per cent decline in the number
of deaths involving heroin and morphine, from 254 in
2010 to 206 in 2011, with a simultaneous 58 per cent
increase in the number of deaths associated with metha-
done, from 174 in 2010 to 275 deaths in 2011.d Across
the United Kingdom, the involvement of multiple sub-
stances implicated in drug-related deaths, notably the
use of opiates/opioid analgesics, benzodiazepines and
alcohol, has been noted,e highlighting the increased risk
associated with polydrug use.
a The definition of this indicator is (a) deaths where the underlying
cause is drug abuse or drug dependence or (b) deaths where the under-
lying cause is drug poisoning and where any of the substances con-
trolled under the Misuse of Drugs Act 1971 are involved.
b Based on data from the United Kingdom, Office for National Statis-
tics, “Deaths relating to drug poisoning in England and Wales, 2011”,
Statistical Bulletin (August 2012).
c Ibid.
d Drug-related Deaths in Scotland in 2011 (National Records of Scot-
land, August 2012).
e Hamid Ghodse and others, Drug-related Deaths in the UK: Annual
Report 2012 (International Centre for Drug Policy, St. George’s, Univer-
sity of London, London, 2013).
0.00
1.00
2.00
3.00
4.00
5.00
6.00
7.00
8.00
9.00
10.00
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Cumulatiiveunweightedaverageof
perceivedtrendsindruguseas
reportedbycountries
Cannabis
Cocaine
Opioids

nabis and ATS was reported as stable, while the use of
cocaine and opiates had increased.
The Americas
In the Americas, a high prevalence of most illicit drugs,
essentially driven by estimates in North America, was
observed, with the prevalence of cannabis (7.9 per cent)
and cocaine (1.3 per cent) being particularly high in the
region.
North America
In North America, the annual prevalence of all illicit drugs
has remained stable and, except for opiate use, is at levels
much higher than the global average.
Overall, use of illicit drugs in the United States has
remained stable, at an estimated 14.9 per cent of the popu-
lation aged 12 years and older in 2011, compared with
15.3 per cent in 2010.27 Prevalence of cannabis use has
also remained stable, though at high levels: 11.5 per cent
27 United States, Department of Health and Human Services, Substance
Abuse and Mental Health Services Administration, Results from the
2011 National Survey on Drug Use and Health: Summary of National
Findings, NSDUH Series H-44, HHS Publication No. SMA 12-4713
(Rockville, Maryland, 2012).
in 2011, compared with 11.6 per cent in 2010 among the
population aged 12 years and older. Cannabis use has con-
tinued to increase among high-school students. In 2011,
an estimated 1 in 15 high-school seniors was a daily or
near-daily user of cannabis. Synthetic marijuana, otherwise
known as Spice or K2, was assessed for the first time;
approximately 11.4 per cent of high school students
reported its use in the previous year. The overall prevalence
of non-medical use of psychotherapeutics (pain relievers,
tranquilizers and sedatives, and stimulants) among persons
12 years or older in the past year also declined, from 6.3
per cent in 2010 to 5.7 per cent in 2011. Similarly, a
decline was observed in the use of inhalants, cocaine, pre-
scription painkillers, amphetamine and tranquillizers
among high-school students. While the prevalence of
“ecstasy” use in 2011 remained stable among the general
population, past-year use of “ecstasy” increased among
twelfth graders and declined slightly for eighth and tenth
graders.
In Canada, the reported use of cannabis in the past year
among the population aged 15 years and older declined
from 10.7 per cent in 2010 to 9.1 per cent in 2011.28 The
28 Information provided by Canada in the annual report questionnaire
(2011). It is reported that, with high sampling variability and a coef-
Driving under the influence of drugs
Worldwide, road traffic injuries are the second most common cause of death for persons between 5 and 29 years of age;
90 per cent of those deaths occur in low- to middle-income countries. The World Health Organization estimates that
1.2 million people die annually from traffic-related injuries and predicts that, by 2030, traffic accidents will be the fifth
leading cause of death. Driving under the influence of drugs or alcohol is a powerful predictor of traffic-related deaths;
it becomes particularly risky when the two are combined.
While the prevalence rate for driving under the influence of drugs is not known in many parts of the world, recent stud-
ies from Brazil, Europe and the United States indicate that it may be more common than previously thought.
In the United States in 2011, 3.4 per cent of those aged 12 and older, or 9.4 million people, reported driving under the
influence of illicit drugs. Estimates from the United States indicate that approximately 66 per cent of drivers who test
positive for illicit drugs also have alcohol in their system, thereby increasing their risk of causing a fatal traffic accident.
In Brazil, a cross-sectional study of 3,398 drivers found that 4.6 per cent of them tested positive for some illicit substance.
Of those who tested positive, 39 per cent tested positive for cocaine, 32 per cent for tetrahydrocannabinol (THC) (can-
nabis), 16 per cent for amphetamines and 14 per cent for benzodiazepines. In another study in Brazil, drug testing on
patients who were admitted to the emergency room after traffic accidents showed that such patients were more likely to
have cannabis in their system than alcohol.
In Europe, in a sample of 50,000 randomly tested drivers from 13 countries, approximately 1.9 per cent of drivers tested
positive for an illicit substance: traces of THC were detected in 1.3 per cent, cocaine in 0.4 per cent, amphetamines in
0.08 per cent and illicit opioids in 0.07 per cent. Additionally, benzodiazepines were found in 0.9 per cent and medical
opioids among 0.35 per cent of European drivers. Among the general driving population, illicit drugs were detected
mainly among young male drivers, and at all times of the day, but mostly at the weekends.
Sources: M. Peden and others, eds., World Report on Road Traffic Injury Prevention (Geneva, World Health Organization, 2004);
United States, Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Results from
the 2011 National Survey on Drug Use and Health: Summary of National Findings, NSDUH Series H-44, HHS Publication No. SMA
12-4713 (Rockville, Maryland, 2012); Substance Abuse and Mental Health Services Administration, “The NSDUH report: state esti-
mates of drunk and drugged driving” (Rockville, Maryland, 2012); European Monitoring Centre for Drugs and Drug Addiction, Driving
Under the Influence of Drugs, Alcohol and Medicines in Europe: Findings from the DRUID Project (Luxembourg, Publications Office of
the European Union, 2012); and Flavio Pechansky, Paulina do Carmo Arruda Vieira Duarte and Raquel Brandini De Boni, Use of Alco-
hol and Other Drugs on Brazilian Roads and Other Studies (Porto Alegre, National Secretariat for Drugs Policies, September 2010).

WORLDDRUGREPORT2013
13
Fig. 13. Trends in drug use in selected South
American countries
A. Chile
Source: Chile, Consejo Nacional para el Control de Estupefa-
cientes (CONACE), Ministerio del Interior y Seguridad Pública,
Noveno Estudio Nacional De Drogas en Población General, 2010
(Santiago, June 2011).
use of other substances, including opioids, cocaine and
methamphetamine, was reported as stable. The use of the
psychoactive plant Salvia divinorum among young people
in Canada remains of concern.
For Mexico, new estimates for 2011, as well as expert per-
ception, indicate a slight increase since 2008 in the use of
cocaine (from 0.4 per cent in 2008 to 0.5 per cent in 2011)
and ATS (0.1 per cent to 0.2 per cent). There was also
some increase in the use of cannabis and opioids, while
use of tranquillizers and sedatives was perceived to be
stable.29
South America, Central America and
the Caribbean
The annual prevalence of cocaine use in South America
(1.3 per cent of the adult population) is comparable to
levels in North America, while it remains much higher
than the global average in Central America (0.6 per cent)
and the Caribbean (0.7 per cent).
Cocaine use has increased significantly in Brazil, Costa
Rica and, to lesser extent, Peru while no change in its use
was reported in Argentina. The use of cannabis in South
America is higher (5.7 per cent) than the global average,
but lower in Central America and Caribbean (2.6 and 2.8
per cent respectively). In South America and Central
ficient of variation between 16.7 per cent and 33.3 per cent, the esti-
mates of amphetamine, “ecstasy” and lysergic acid diethylamide (LSD)
should be interpreted with caution. Since the coefficient of variation
was greater than 33.3 per cent and/or the number of observations was
less than six, the past-year estimates for opioids, tranquillizers and
sedatives, and Salvia divinorum are suppressed and not reported.
29 Information provided by Mexico in the annual report questionnaire
(2011).
Fig. 12. Trends in annual prevalence of drug
use among the population 12 years and
older in the United States, 2000-2011
Source: United States, Department of Health and Human Services,
Substance Abuse and Mental Health Services Administration,
Results from the 2011 National Survey on Drug Use and Health:
Summary of National Findings, NSDUH Series H-44, HHS Publica-
tion No. SMA 12-4713 (Rockville, Maryland, 2012).
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
Annualprevalence(%)
Cannabis Cocaine
Opiates "Ecstasy"
Psychotherapeutics Pain Relievers
Tranquillizers Stimulants
Methamphetamine Sedatives
C. Argentina
Source: Argentina, Secretaría de Programación para la Prevención
de la Drogadicción y Lucha contra el Narcotráfico (SEDRONAR),
Tendencia en el Consumo de Sustancias Psicoactivas en Argentina
2004-2010: Población de 16 a 65 Años (June 2011).
0
1
2
3
4
5
6
7
8
Annualprevalence(%)
2004 2006 2008 2010
Cannabis Opioids
Cocaine ATS
"Ecstasy" Tranquillizers
0
1
2
3
4
5
6
7
8
2000 2002 2004 2006 2008 2010
Annualprevalence(%)
Cannabis Cocaine
ATS "Ecstasy"
Tranquillizers
0
2
4
6
8
10
2001 2006 2011
Annualprevalence(%)
Cannabis
Cocaine
ATS
Sedatives and tranquillizers
B. Uruguay
Source: Uruguay, Junta Nacional de Drogas, Observatorio Uru-
guayo de Drogas, Quinta Encuesta Nacional en Hogares sobre
Consumo de Drogas: Informe de Investigación (May 2012).

2013 World Drug Report Insights

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